Why doctors worry about Trump’s warnings against Tylenol in pregnancy

Tylenol displayed for sale behind a locked anti-theft barrier at a pharmacy in Washington, DC. (Courtesy: Reuters photo)

US President Donald Trump and Health Secretary Robert F. Kennedy Jr. caused outrage this week by urging pregnant women not to take Tylenol, suggesting there is a possible link between the active ingredient acetaminophen and autism. Trump urged women to "fight like hell" not to take it, saying there was "no downside" to avoiding the medication. But health professionals say the advice overlooks well-documented risks of not treating fevers in pregnancy, the New York Times reported.

Acetaminophen as the only safe option

For decades, acetaminophen — also referred to as Tylenol — has been considered the safest option for pregnant women to take in order to relieve pain or fever. Other drugs, such as ibuprofen, are typically avoided because research illustrates that they are toxic to the foetus. Doctors affirm that, in contrast to any other medication, acetaminophen is the only one they can safely recommend during pregnancy without severe risk of complications.

The real dangers of fever in pregnancy

Scientists quote firm evidence that links first-trimester fevers with a higher risk of birth defects, said Dr. Eric Benner, who is a neonatologist at Duke University. These include neural tube defects, heart defects and cleft palates, he added. Even though the conditions are rare, decades of medical research attest to the fact that the dangers are greatly heightened if fevers are left untreated, so acetaminophen is an important shield of protection.

Why the autism link remains unsubstantiated

Trump's statements revived old rumours that acetaminophen causes neurodevelopmental disorders such as autism. Several studies have been done on the prospect, but the results have been inconclusive. Scientists point out that correlation is not necessarily causation and that alternative explanations, such as genetics or complications during pregnancy, may be responsible for the trends observed. No credible medical group has made a judgment that acetaminophen causes autism.

Physicians dread confusion among pregnant women

Health workers are now worried that Trump's blanket warning will encourage expectant mothers to avoid the drug altogether. Fevers, left untreated, can unnecessarily raise the risk of birth defects. "You risk seeing more instances of those types of birth defects possibly for nothing," warned Dr. Benner. Physicians echo that most children born following maternal fevers are healthy, but underscore that treatment reduces risk further.

Balancing risks and decisions

Medical doctors argue that the true issue is balancing risks. While a degree of uncertainty remains about the long-term effects of acetaminophen, evidence of complications due to fever is considerably stronger and more widespread. To most doctors, that makes Tylenol the lesser of two evils in comparison to the known consequences of withholding fever reduction. Warning women against it, they argue, would produce fear rather than informed decision-making.

A larger political context

The furore is unfolding against the backdrop of political battles over science and health advice. Trump repeatedly has questioned medical conventional wisdom about vaccines and medicines, and Kennedy has long been known to promote alternative theories about public health risks. By politicizing Tylenol, their remarks risk undermining trust in medical advice and planting confusion among pregnant women at a vulnerable time.

The bottom line for pregnant women

Physicians recommend pregnant women discuss their health care providers before using any drug but affirm categorically that acetaminophen remains the accepted treatment for fever and pain during pregnancy. The consensus is absolute: while all possible risks continue to be researched, omission of fever threatens a proven risk over unsubstantiated fear.